Comments

Congratulations on raising the issues of health care funding in PNG. The country is facing a major crisis in healthcare funding, illustrated by the plight of NGO's providing care for people with HIV. Imagine the implications if health care funding by government in Australia were to drop 30% in one year. It would damage the entire sector, and not just a specific , though important, disease. It is a mistake to assume that the HIV issues are more important than say maternal health, child health, or immunization,or NCDs. HIV is different as its response is largely donor funded, and it has a high political profile internationally. Many other parts of the sector are in equal if not more distress. It is a systemic problem, not one related to a specific disease or a group of NGOs. The roots of this crisis lie in historic underfunding of the PNG health sector. For most of the last 20 years, the per capita spend on health has been less than the minimum level required to achieve global health goals such as the MDGs - which PNG unsurprisingly failed to reach, as it never had a level of resourcing and capacity that made it possible. To suggest there is "little to show for the decades of effort and millions of dollars that the Australian aid program has invested in capacity building in PNG" is problematic. The response needs to be far more nuanced - building on success applies as much to Aid Programs as recipients. There is ample evidence of effective, and ineffective Australian health capacity building. Furthermore, Australian Government Aid has been a minority funder of health in PNG for years, the bulk of the resource comes from the PNG government. As noted above, the chronic underfunding has led to huge capacity deficits such as a shortage of 20,000 health workers). The lack of impact of capacity building efforts is because of their size as much as their effectiveness. You have previously documented the rise and fall of both the Kina and the government revenue and how "surprised" everyone was that this had happened. There has been very little commentary on how the oil and gas revenues extracted from the country have managed to be maintained during the global low prices , targets met and exceeded, while the full impact has been borne by the PNG government with drastically reduced government revenue and its ability to spend on social services such as health and education. It would seem timely to explore how the benefits and risks of these developments have been shared between government and the extractive industry, particularly when times are tough. Your comments about aid predictability apply equally to revenue predictability in terms of its impact on the wider health sector. Health in PNG desperately needs a sustainable funding mechanism, that gives it a chance of meeting the health SDG. That will need to be a combination of government and donor funding.

Am so pleased to read about what you are doing in terms of dealing with gender based violence. Am a female nurse in Western Highlands Provincial hospital as a Family support center clinical supervisor.We are also dealing with this issue and we are treating ,providing counselling and doing referral of survivors of GBV . Every day we are receiving survivors of physical and sexual violence.Every day ,every where ,there is violence taking place whether its in a home,workplace or in town.Our female staff sometimes get sick leave and miss work because of intimate partner violence especially physical assault which affects our work roster for providing three shifts in a day.The statistics that we have at the center are the reported cases but the unreported cases we don't know. There fore ,its a big issue in the country and I agree that our Government has put a lot of effort in making laws and policies to address and reduce violence in the country.

We're not arguing against removing the requirement of registration under the SWP. I'm not sure it is sensible to say that all employers who hire backpackers should be registered. But at a minimum, labour-hire companies should all be licensed, regardless of whom they hire.

Hi Tara / Grant I'd love to get a copy of your follow up visit (in June this year) after your data analysis later in the year is over and when you publish the research report. I have a cousin brother who is a standards officer for the Baimuru sub-district (Primary School) and he does a wonderful job, but lacks resources to move around. Another cousin sister is a nursing officer in one of the functioning sub health centres. Thank you,

Tara & Grant Thank you so much for making the 2nd trip back to Gulf Province. Yes, I know the feeling when teachers express gut wrenching times/situations they experience in making sure they try their best in implementing the policies of the Government, especially in Education & Health. Over my 6 years (2011 - 2016) in working in the province as a Oil & Gas employee (exploration), I have come across many similar situations described here. My company I work has been as part of its CSR Policies, assisted many remote schools and health centres. I once donated a pretty expensive Solar vaccine Fridge (K30,000.00) to a remote health centre after I assisted a nearby health centre nursing staff manage a measles outbreak in a number of villages near the exploration drilling site. And I have helped deliver school materials where the Govt was not able to. Gulf Province by all means is not remote. It is one of only two provinces in this country that is connected to the Capital City by road, hence it should be taking advantage of this unique position. Yet it is not doing so. It is far cheaper to move things in bulk to Kerema the provincial capital by road from Port Moresby and then re-distributing by Sea, River and Air. The major issue is the proper use of funding to ensure this happens. Unfortunately, most often this is not the case. Contributing issues of good governance are also major concerns when development priorities are mis-placed by leaders (at the political & administrative level). This is also exacerbated by lack of proper planning by key bureaucrats & total negligence by political leaders to lead changes. The end result is lack of development all areas of the development in the province. Gulf has the people at the provincial, district and local level to bring about changes in the people's lives in the key social indexes but need to have good leadership at all levels of the society (Province). Thank you,

Thanks for your response Robin. I certainly agree the GCF is only one avenue of climate finance support and the $100 billion everyone is looking for needs to come from many sources including the private sector, bilateral and multilateral donors. But the implied suggestion that Pacific can look elsewhere for climate funds generates several issues worth considering. Two issues that I find particularly compelling are: 1. The global community doesn't really want more climate funds. You will recall a few years ago that many donors were criticised for their 'proliferation of funds'. The criticism's storyline was that there were too many special interest or regional funds were creating inefficiency for recipients. Perhaps to some extent that is why we ended up with one humongous global fund - the GCF. I don't think this issue has gone away and for the foreseeable future there will be little appetite for setting up a 'Pacific Climate Fund'. 2. The GCF offers a development opportunity that donors can rarely provide: direct access to climate funds. And provides them with a kind of self-determination they find very attractive. My discussions with Pacific leaders lead me to believe it is not just about the money, it is to some extent about independence. I agree that the GCF's 'one fund for all' approach is very ambitious. But the alternative 'one fund for some' is - at the moment at least - even less appealing.

Hi Stephen, I agree that making them less onerous will be beneficial. I disagree that removing the requirement that they be registered is one of the more sensible options. If Australian government agencies including Fair Work Australia have limited resources, it is preferable that they know which employers they need to monitor by way of a registration process rather than trying to monitor everyone which creates the risk of widespread abuse as seen with the backpacker experience.

In an ideal world , superannuation collected from seasonal workers acts as a compulsory savings scheme uplifting the amount of cash that can be repatriated. The reality is that the process of getting it back is cumbersome and if workers do not receive assistance from an employer or agent it is often foregone. A better option is to facilitate payments into the national provident funds in home countries to assist with developing a buffer against financial shocks.

HI Tess, We're not talking about removing the regulations, but making them less onerous, in sensible ways. See <a href="https://devpolicy.org/reforming-the-seasonal-worker-program-suggestions-from-an-employer-20150310/">this blog</a> for some very practical suggestions towards that end.

Thanks Nicole. Fair points in your first para. On the second, I understand that the government is not abolishing super for backpackers but basically confiscating it via tax. On the third, I don't think the Australian government prefers backpackers because of the cultural aspects, but because (a) employers prefer their flexibility and (b) they spend what they earn in Australia. But it is slowly changing, and the SWP is growing over time.

Very important message : Diabetes is still a major health challenge in the Pacific with social and economic implication. Diabetes is the "face of NCD" in the Pacific. We must look after it as we look after our faces.

SWP is no longer referred to as Pacific Seasonal Worker Program. Additionally, referring to participants solely as 'Pacific Islanders' with the inclusion of Timor-Leste, which doesn't self-identify as a PiC neither in terms of culture nor geographically speaking. Other than this, I agree and support your proposed goal of "Reducing the number of backpackers and increasing the number of Pacific seasonal workers should be a central policy goal for migration in Australia". I think broad reforms are due for both labour migration schemes. There are at present calls from the horticultural sector for parity in tax rates between the two schemes, I would meet this suggestion with a request for the government to remove the labour market testing requirement from the SWP as an effort toward achieving a parity in administrative burden between the two schemes. It would also be a shame to see the removal of superannuation from one scheme and not the other. If the government removes the requirement to pay super to backpackers, this only increases their relative attractiveness further reducing potential employer's motivation to pursue approval to employ seasonal workers. If the government removes superannuation from both programs, the seasonal workers, who are often living in very poor conditions in their home country, will lose vital funds which assist them to improve their quality of life toward an acceptable level. I think reforms which support a shift from reliance on unregulated backpacker labour to the SWP is unlikely to occur because for the most part, the Australian people and the present government preference the cultural exchange objectives espoused by the WHM visa over the development objectives inherent with the SWP.